POS0661 MAJOR COST SAVINGS ASSOCIATED WITH BIOLOGIC DOSE REDUCTION IN PATIENTS WITH INFLAMMATORY ARTHRITIS
Authors: A. Rehman, S. Tariq, J. Kumar, L. Martin, C. Bannon, T. Duffy, E. Murphy, J. Stack, M. Barry, C. L. Murphy
Journal: Annals of the Rheumatic Diseases (2022)

Background Anti-TNF drugs have dramatically improved the management of inflammatory arthritis (IA). Although the introduction of biosimilars have reduced the cost, chronic use of biologic agents has a high impact on healthcare expenditure. This study evaluated the cost effectiveness of a dose reduction strategy for the most commonly used anti- TNF drugs over a period of 10 years in patients with IA in remission. Objectives The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS) would remain in remission after 10 year period, following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. Methods This prospective, non-blinded, non-randomised study was commenced in 2010. Patients with IA, Rheumatoid arthritis (RA),ankylosing spondylitis (AS) and Psoriatic arthritis (PsA) who were in remission as defined by disease activity indices (DAS28&lt;2.6, BASDAI&lt;4), and were offered Anti TNF dose reduction. Patients on etanercept were reduced from 50mg weekly to fortnightly, adalimumab 40mg once monthly instead of fortnightly. Patients were assessed for disease activity at 1, 4 and 10 years following reduction in dosing frequency.Cost saving was calculated by deducting the total annual cost of the biologic agent used over 10 years compared with the cost if the dosing interval had not changed. Results Seventy nine patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n=45), 13% psoriatic arthritis (n=10) and 30% ankylosing spondylitis (n=24). 57% (n=45) were taking etanercept and 43% (n=34) adalimumab. The percentage of patients who maintained dose reduction at 10 years was 9% (n=7). Of the total 48 patients who were successfully dose reduced at year 1 (n=42), (69%, n=29) were able to maintain the dose reduction up to 4 years and 9% (n=7) maintained this dose reduction up to year 10. The estimated cost saving was €4,928 per patient per year. Estimated cost savings for 7 patients on reduced dose was €344,952.88 over 10 years. Conclusion Anti TNF dose reduction strategy in patients with IA results in substantial cost savings. Implementation of a dose reduction strategy while monitoring of disease activity reduces the financial impact of the use of biologic therapies. Further studies should be done to identify which patients are more likely to remain in remission while on dose reduction. References [1]Bonafede MM, Gandra SR, Watson C, Princic N, Fox KM. Cost per treated patient for etanercept, adalimumab, and infliximab across adult indications: a claims analysis. Adv Ther. 2012 Mar;29(3):234-48. doi: 10.1007/s12325-012-0007-y. Epub 2012 Mar 9. PMID: 22411424. [2]Joaquín Borrás-Blasco, Antonio Gracia-Pérez, J Dolores Rosique-Robles, MD Elvira Casterá &amp; F Javier Abad (2014) Clinical and economic impact of the use of etanercept 25 mg once weekly in rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis patients, Expert Opinion on Biological Therapy, 14:2, 145-150, DOI: 10.1517/14712598.2014.868433 [3]Carter CT, Changolkar AK, Scott McKenzie R. Adalimumab, etanercept, and infliximab utilization patterns and drug costs among rheumatoid arthritis patients. J Med Econ. 2012;15(2):332-9. doi: 10.3111/13696998.2011.649325. Epub 2012 Jan 6. PMID: 22168788. Disclosure of Interests None declared